Editorial Credits/ Crédits éditorials

Subscription Rates /Prix d'abonnements

Advertising Rates / Tarifs publicitaires (PDF)

Guest Editorial
Palliative Care: An Opportunity for Mental Health Professionals
Harvey Max Chochinov
(PDF)

In Review
Structured Interview Assessment of Symptoms and Concerns in Palliative Care
Keith G Wilson, Ian D Graham, Raymond A Viola, Susan Chater, Barbara J de Faye, Lynda A Weaver, Julie A Lachance
(PDF)

Palliative Care for Families: Remembering the Hidden Patients
Linda J Kristjanson, Samar Aoun
(PDF)

Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality
William Breitbart, Christopher Gibson, Shannon R Poppito, Amy Berg
(PDF)

Review Paper
Prevalence Studies of Substance-Related Disorders: A Systematic Review of the Literature
Julian M Somers, Elliot M Goldner, Paul Waraich, Lorena Hsu
(PDF)

Original Research
Stress and Psychological Impact on SARS Patients During the Outbreak
Siew E Chua, Vinci Cheung, Grainne M McAlonan, Charlton Cheung, Josephine WS Wong, Erik PT Cheung, Marco TY Chan, Teresa KW Wong, Khai M Choy, Chung M Chu, Peter WH Lee, Kenneth WT Tsang
(PDF)

Brief Communication
Psychological Effects of the SARS Outbreak in Hong Kong on High-Risk Health Care Workers
Siew E Chua, Vinci Cheung, Charlton Cheung, Grainne M McAlonan, Josephine WS Wong, Erik PT Cheung, Marco TY Chan, Michael MC Wong, Siu W Tang, Khai M Choy, Meng K Wong, Chung M Chu, Kenneth WT Tsang
(PDF)

Schizophrenia: The Quest for a Minimum Sense of Identity to Ward Off Delusional Disorder
Marie-Christine Noël-Jorand, Max Reinert, Sébastien Giudicelli, Daniel Dassa
(PDF)

Diabetes, Tardive Dyskinesia, Parkinsonism, and Akathisia in Schizophrenia: A Retrospective Study Applying 1998 Diabetes Health Care Guidelines to Antipsychotic Use
Emmanuelle Lévy, Howard C Margolese, Lawrence Annable, Guy Chouinard
(PDF)

The Psychosocial Effects of Being Quarantined Following Exposure to SARS: A Qualitative Study of Toronto Health Care Workers
Emma Robertson, Karen Hershenfield, Sherry Lynn Grace, Donna Eileen Stewart
(PDF)

Hard Times and Good Friends: Negative Life Events and Social Support in Patients With Seasonal and Nonseasonal Depression
Erin E Michalak, Edwin M Tam, Chinnapalli V Manjunath, Lakshmi N Yatham, Anthony J Levitt, Robert D Levitan, Raymond W Lam
(PDF)

Letters to the Editor
(PDF)

Combined Transcranial Magnetic Stimulation and Right Unilateral Electroconvulsive Therapy in Patients With Treatment-Refractory Depression

Re: Treatment Noncompliance With Orally Disintegrating Olanzapine Tablets

Reply: Treatment Noncompliance With Orally Disintegrating Olanzapine Tablets

Quetiapine in the Management of Psychosis Secondary to Huntington's Disease: A Case Report

Ziprasidone-Induced Lupus Erythematosus

Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Letters to the Editor

Re: Treatment Noncompliance With Orally Disintegrating Olanzapine Tablets

Dear Editor:

Dr Freudenreich reported on the case of a woman, aged 52 years, with chronic schizophrenia and covert noncompliance with the orally disintegrating formulation of olanzapine (1). The patient was able to “cheek” the medication wafer behind her front teeth near the gum line. Consequently, no clinical improvement was observed. Once this was discovered, the patient was placed on haloperidol decanoate. Dr Freudenreich concluded that fast-dissolving medication is no substitute for parenteral medication.

Although adherence to medication is an important concern, parenteral medication is not always the answer. Treatment compliance to haloperidol decanoate is not guaranteed if the patient fails to attend clinic appointments. Moreover, haloperidol is inferior in terms of effects on negative symptoms, cognition, and mood, compared with atypical antipsychotics (2). It is possible that, by persisting with a treatment course of an atypical antipsychotic, improvements in overall well-being, including cognition and mood, may lead to improved insight and a better functional outcome.

We have also observed the “cheeking” of olanzapine wafers in a small minority of patients. One patient placed the wafer on top of a rear molar, allowing for the surreptitious removal of the agent a few minutes later. Another method is to place a small piece of tissue or paper towel in the mouth, placing the wafer on top of this barrier. All methods can be easily managed by having the patient swish and swallow water after administering the medication. The characteristics of the wafer make it impossible for “cheeking” to occur, compared with regular pills or capsules.

References

1. Freudenreich O. Treatment noncompliance with orally disintegrating olanzapine tablets. Can J Psychiatry 2003;48:353–4.

2. Citrome L, Volavka J. Atypical antipsychotics—revolutionary or incremental advance? Expert Review of Neurotherapeutics 2002;2(1):69–88.

Leslie Citrome, MD, MPH
Orangeburg, New York